Elsie Kroeger and her husband, Tim, had been looking forward to a spring break vacation with their grandkids for months.
But on the day of their departure, Elise was struck with severe stomach pain and nausea.
“I told them, ‘Go on without me, I’ll meet you there when I feel better,’” she recalls.
As her family headed to their vacation destination, Elsie drove to the emergency room. Doctors there detected a suspicious mass in her colon, and referred her to a specialist. Further tests revealed she had stage 4 colon cancer, the most advanced form of the disease.
“I’d been having bowel problems for a year,” she says, “but assumed it was irritable bowel syndrome or a sensitive stomach.”
Kroeger decided MD Anderson was her best hope. Doctors prescribed chemotherapy and performed surgery, but the cancer kept growing. Malignant cells crept outside her colon and formed tumors in her liver.
“Up to 70% of people with colon cancer eventually develop liver metastases,” says Armeen Mahvash, M.D., associate professor of Interventional Radiology. “That’s because the blood supply from the intestines is connected directly to the liver, so the malignant cells travel through the bloodstream.”
With her cancer spreading and her options dwindling, Kroeger enrolled in a clinical trial designed for people whose colon cancer, like hers, didn’t respond to the chemo and progressed to the liver.
Patients in the trial are injected with tiny, radioactive glass beads called TheraSpheres that travel through the bloodstream to the liver to kill cancer cells. Chemotherapy also is given to control cancer that may be lurking elsewhere in the body. The study is designed to find out if TheraSpheres plus chemo are more effective than chemo alone.
MD Anderson is among 100 hospitals participating in the trial worldwide, and has more patients enrolled than any other site.
“This offers one more option to patients who have none,” says Mahvash, M.D., leader of the MD Anderson segment of the trial.
How it works
Before treatment begins, Mahvash “maps” the patient’s liver.
“During this trial run, we inject contrast dye into the blood vessels, which identifies on X-ray the vessels that route blood out of the liver to the rest of the body,” he explains. “We then block off, or embolize, those vessels to prevent the TheraSpheres from traveling outside the liver during treatment and harming other tissues and organs.”
The pre-treatment mapping also allows doctors to customize bead delivery to the exact location and size of each patient’s liver tumors.
With mapping done, the patient goes home, then returns a week later for treatment.
Mahvash starts by making a small slit in the patient’s groin. He then inserts a plastic catheter into the incision and snakes it up through the arteries to the liver.
With the tip of the catheter in place, he injects millions of the radioactive beads directly into the tumors. Each microscopic bead is smaller than a grain of salt and is embedded with the radioactive isotope yttrium, also called Y-90. The beads lodge in the tumor vessels, stopping blood flow and emitting an extremely high dose of radiation to kill cancer cells.
The entire procedure is finished in about an hour.
“The radiation kills the tumors from within,” Mahvash says, “and targets multiple tumors in the liver all at once, while sparing healthy liver tissue.”
The tiny beads deliver up to 40 times more radiation than conventional cancer radiation therapy, which uses a machine to aim high-energy radiation beams from outside the body into the liver.
Conventional radiation is given five days a week for several weeks. TheraSpheres are typically delivered in one session.
The beads will continue to release radiation over the course of two weeks following treatment, gradually decreasing to insignificant levels and with few side effects.
Patients go home about three hours after the treatment and can resume their regular activities in two days. The most common side effect is two weeks of fatigue, the same as traditional radiation.
“This minimally invasive and precise procedure has been shown to improve patients’ quality of life and increase their life expectancy,” says Mahvash.
“It allows us to treat a very difficult disease in an elegantly simple way.”
Besides treating colon cancer that has spread to the liver, TheraSpheres have proven useful in treating primary liver cancer that originates in the liver.
Researchers are now starting to think about how the technology can help handle other forms of cancer. Early studies show kidney cancer may be their next target. The blood supply to the kidneys is very rich, which could make them good candidates for the irradiated beads.
“The more vascular the tumor,” Mahvash says, “the more beads will get concentrated in the tumor, and the better the effect.”
Treating colon cancer that’s spread to the liver with radiation-containing beads is considered palliative, meaning it typically does not provide a cure, but can help slow down or halt the growth of the disease and alleviate symptoms.
“Some patients who are given a window of six to 10 months to live end up living significantly longer,” Mahvash says. “This means more time to attend a high school or college graduation, walk a daughter down the aisle, or see a grandchild born.”
Not long after her TheraSphere treatment, Elsie felt well enough to enjoy a night on the town with her husband. The couple celebrated their 46th wedding anniversary at a local restaurant and danced to the first song played at their wedding – “Misty” by Johnny Mathis.
“We swayed and held each other and cried,” says Elsie, who’s looking forward to attending her granddaughter’s wedding later this year.
“Added time to life is priceless,” Mahvash says. “We want people facing this diagnosis to know about this treatment option.”